Optimal Reimbursement and Malpractice Sharing Rules in Health Care Markets

When health care sponsors such as HMOs or PPOs can use "utilization reviews" in order to indicate to the provider what type of treatment to administer to the patient based upon a diagnosis that is established by the provider, it is possible to implement the "first best" levels of investment in cost control efforts and in aggressiveness of treatment. The implementation of the "first best" requires the utilization of the prospective reimbursement rule accompanied by the removal of all malpractice liabilities from the provider. In contrast, when the type of treatment cannot be enforced by the payer, implementation of the "first best" is not feasible if the payer places a higher weight on the welfare of consumers than that of providers in its objective function. In this case, the reimbursement scheme deviates from the prospective rule, and the provider assumes liability to part of the cost incurred by society as a result of unsuccessful medical outcomes. When the payer can enforce treatment only partially by establishing bounds on the range of acceptable treatments, a minimal acceptable standard will be established and the outcome will be an intermediate case between the above two extremes.     

Can a Mixed Health Care System be Desirable on Equity Grounds?*

Should health care provision be public, private, or both? We consider this question in a setting where people differ in their earnings capacity and face some illness risk. We assume that illness reduces an individual's time endowment when waiting for treatment. Treatment can be obtained in a competitive private sector (through private insurance) or in the National Health Service (NHS) where it is provided free of charge but after some (endogenous) waiting time. The equilibrium in the health care sector consists of a waiting time in the NHS such that no patient wants to switch health care provider. This equilibrium is governed by two public policies: the income tax system and the size of the NHS. We find that: (i) a mixed system with a small NHS is never desirable; (ii) actuarially fair sickness insurance is never desirable either; (iii) a mixed system with a sufficiently large NHS may improve on a pure public system if the dispersion of earnings capacities is large enough; and (iv) the welfare gains from such a mixed system are not likely to be significant.     

规范私募基金 重点在于规范市场

私募基金合法化已经基本上成为共识,但我们认为,尽管界定私募基金的性质、规定其资格条件等问题十分重要,更重要的却是规范资本市场,遏止投机,消除产生投机的制度根源。     

Supply and Demand for Medical Care: Or,Is the Health Care Market Perverse?

The argument that health market behaviour is idiosyncratic is reviewed and evidence concerning 'Supplier Induced Demand' is presented. The theoretical basis and implications of this pivotal hypothesis are discussed.     

Negotiation over Intellectual Property Rights Protection in a Mixed Market

This article models a North–South negotiation under a mixed oligopolistic setting where a public firm in the South and a private firm from the North compete in the southern market. The southern firm is a public one whose objective is a weighted sum of the South's social welfare and its own profit, whereas the northern firm is a pure profit maximizer. The North provides a quid pro quo in exchange for the strengthening of the enforcement of intellectual property rights (IPR) protection in the South. We show that when the northern and southern firms engage in quantity competition in the southern market, the southern government's optimal choice is either complete protection or complete violation. We show this to depend on the southern government's valuation of the quid pro quo. Moreover, strengthening IPR protection will deepen the privatization process in the South, though it brings about a social welfare loss to the South.     

医养结合与老年人健康养老

医养结合是我国社会养老服务体系的核心内容之一,也是实现养老服务高质量发展的重要内容。文章利用CHARLS2015和2018两期数据,以2016年确立国家级医养结合服务试点作为准自然实验,运用双重差分法实证检验了社区居家医养结合服务对于老年人健康养老的影响。研究发现：（1）社区居家医养结合服务提高了老年人的健康自评,优化了老年人医疗服务利用水平,并显著促进了慢性病管理与门诊就诊随访概率,但对老年人身体机能和精神健康层面的改善并不明显。（2）服务效果受到老年人的个体因素（年龄、性别、收入、婚姻状况等）与代际因素（居住区域、子女个数、是否有子女照料、子女受教育程度等）的异质性影响。（3）机制检验方面,体检、日间照料、上门巡诊、娱乐活动服务等显著提高了老年人的健康自评,优化了慢性病管理和老年人的医疗服务利用水平,提升了老年人的精神健康水平。文章研究认为,社区居家医养结合服务应当重新梳理其主体行为逻辑,逐步优化顶层设计,完善关联制度衔接,构建医养结合服务模式、机制与需求多维度衔接的动态调整机制,弄清不同层次人群在医养结合服务中的现实需求,打破制度壁垒,提高资源与政策制度的衔接能力。文章的研究为进...     

市场经济体制中政府角色的基点：干预特定产业

本文概括了政府调控和干预经济发展的四种模式。在此基础上论证了政府干预特定产业发展模式的必要性、现实性和阶段性。     

长期护理保险在山西的市场调查与发展对策研究

因家庭养老功能的弱化、护理费用的高涨及现有社会保障制度的不完善,使得长期护理保险自面世以来倍受人们的关注.这一保险产品目前在山西存在巨大的有效需求,而市场供给却为空白,巨大的供需缺口孕育着巨大的市场潜力.为此保险公司应结合山西地区发展实际,有针对性地改造现有产品,开发新产品,政府也应给予适当的财税优惠政策,并最终应将长期护理保险纳入社会保险范畴.     

以健康旅游为抓手推动医养结合创新发展

为了落实习近平总书记有关要大力发展健康事业,做身体健康的民族的指示精神,推动健康中国国家战略的实施,是进入新时代广大人民群众非常关切的社会问题。在大健康时代的趋势背景下,健康旅游可能会成为未来人们出行的常态化选择。中医药这一民族瑰宝与健康和旅游结合起来,以健康为目的,以旅游为路径,推动医养结合事业深度发展,使我们看到了一个健康新业态的形成。以金秀康养旅游目的地建设为契机,将健康旅游作为抓手,结合瑶医瑶药特色推动医养结合的创新发展,值得探索与期待。     

Mixed Market Competition in a Quality Differentiated Duopoly Model An Approach to Banking Sector

This paper attempts to develop a theoretical framework to investigate the competitive implications of quality choices of financial institutions whereby they charge prices to consumers based on their willingness to pay for the service qualities in the mixed market scenario under vertical product differentiation model. Initially, it analyzes benchmark equilibrium solutions of monopoly and duopoly to establish the degree of quality differentiation between two private banks in an uncover market configuration. Further, it estimates the quality differentiation between private and public banks, and examines the interaction between two market structures keeping public bank as both leader and follower, and then measures the social welfare from different prospectives. The explicit operation of two stages Nash equilibrium game forecasted that public banks＇ monopoly seems to be still better than a private banking, and it is socially optimal. The outcome demonstrates a significant importance of vertical quality differentiation for policy implication in banking industry and provides an insight on the reasons of particular co-existence of public and private banking services in the specified location. In this context, it is concluded that the presence of public banks in banking industries is a crucial condition for obtaining the higher range of social welfare.     

Do Consumers Purchase Too Much Health Insurance? The Role of Market Power in Health‐Care Markets

Several authors have suggested that consumers purchase too much health insurance in private markets. We readdress this issue within a model that combines excess health‐care demand due to health insurance with market power due to monopolistic production of health‐care services. We evaluate the market equilibrium in terms of consumer welfare and social welfare. The consumer welfare criterion suggests that in the market equilibrium consumers in fact purchase too much health insurance coverage. The social welfare criterion, in contrast, suggests that because profits of the health‐care industry are properly accounted for, consumers should purchase more insurance coverage than they choose to do in the market equilibrium.     

管办分离是医药业“三改联动”的必由之路

三改联动可以概括为一体两翼,医疗卫生制度改革是主体,医疗保险制度改革和药品流通体制改革是两翼。基于我国国情,管办分离最简洁的方法就是将各级国有医院从卫生行政部门移交各级国资委。同时在社会医疗保险制度改革中实行管办分离,激发医疗保险机构的信息功能和谈判功能以强化医疗供方声誉机制,带动药品流通体制改革。     

The Need for Regulating a Bayesian Regulator

This paper analyzes the Baron and Myersons (B–M) (Econometrica 50: 911–930 [1982]) scheme of monopoly regulation, a standard representative of Bayesian mechanisms. As is well known, the hboxB–M mechanism (and other related mechanisms) have as an explicit starting point the assumption that the regulator has an unchallenged prior belief about the cost function of the regulated monopolist.We analyze here the consequences resulting from the possibility that this prior belief may be subject to influence or manipulable. As we show in detail, under the B–M scheme, consumers and the regulated monopoly are highly sensitive to the regulators prior belief about the (private) cost information of the monopolist. Therefore, if a regulators beliefs are unaccountable to and unverifiable by a higher ity, the regulator has both the incentive and the possibility to change and/or misrepresent his prior belief when facing pressure or payoffs from interest groups representing consumers or the regulated firm. The results here show that the outcomes under a B–M mechanism favoring one or another interest group can vary over a wide spectrum. The results are consistent with capture theory and rent-seeking explanations of monopoly regulation and suggest the need to exercise care in using the insights and results of Bayesian regulatory theory to inform practice.     

中国城乡老年健康及照料状况研究

人口老龄化背景下我国城乡的老年健康及老年照料问题日益严重。利用中国城乡老年人状况调查数据、全国残疾人抽样调查数据以及国家卫生服务利用调查数据,从两周患病率、慢性病患病率、残疾水平、自评健康以及健康预期寿命等方面分析了我国城乡老年人的健康状况,探讨了目前我国城乡老年人的照料提供来源。提出了人口老龄化趋势下提高老年健康水平,应对老年人口照料危机的政策建议。     

Female Autonomy and Health Care in Developing Countries

Decisions within the household determine the allocation of resources. Theory suggests that the more autonomous women are within the household, the greater influence they will have in that allocation. This paper utilizes several measures of a woman's autonomy within the household. It is hypothesized that the greater the woman's autonomy, the more likely she will be to visit a doctor, rather than other traditional sources of healing/care, when ill. This hypothesis is tested using data drawn from Uttar Pradesh and Bihar in India. The results lend support to the importance of autonomy for a woman in increasing her likelihood of visiting a medical doctor when ill. Additionally, the results show that socio‐economic differences go a long way in explaining differences in healthcare choices for the sick.